The changing face of coeliac disease.

Coeliac disease was considered to be a rare childhood affliction causing malabsorption and weight loss. It is now recognized to occur at any age with a range of non-specific manifestations including anaemia, recurrent miscarriages, neuropsychiatric disorders and osteopenia. This article summarizes advances in diagnosis and innovations in therapy.

Effect of wrist restraint on maximal exercise capacity in healthy volunteers.

Each year, reports occur of deaths in individuals, while struggling against physical restraint. The mechanism of these deaths remains unclear. This study aimed to determine the effect of wrist restraint on cardiorespiratory function during maximal exercise. Twelve healthy volunteers underwent 3 incremental maximal exercise tests on a cycle ergometer. In a randomized order, they exercised while unrestrained, with the wrists tied in front of the body or wrists tied behind the back. The primary outcome measures were the number of minutes exercised in each position and heart rate and whole blood lactate level for each stage and on reaching maximum exercise capacity. The mean exercise duration was 19 minutes 6 seconds unrestrained (95% confidence interval [CI] 16 minutes 52 seconds to 20 minutes 57 seconds), 18 minutes 51 seconds (95% CI 17 minutes 51 seconds to 20 minutes 50 seconds) with arms restrained in front and 16 minutes 51 seconds (95% CI 14 minutes 6 seconds to 19 minutes 20 seconds) with the arms restrained behind the body (P = 0.16). There was no significant difference in heart rate or lactate measurements. It is probable that other factors make a more important contribution than wrist restraint behind the body to cardiorespiratory compromise in a struggling and fatigued individual.

The cardiopulmonary effects of physical restraint in subjects with chronic obstructive pulmonary disease.

Police officers commonly encounter violent individuals in their line of duty, with the use of physical restraint sometimes being necessary. A major criticism of previous studies of the effect of restraint on cardiac and pulmonary function has been that they have only recruited young healthy adults. This study aims to assess the cardiopulmonary effects of restraint positioning in individuals with chronic obstructive pulmonary disease (COPD). Eight patients with stable COPD were recruited. Subjects were randomly allocated to the following five positions: Wrist restraint behind the body whilst seated; wrist restraint in front of the body whilst seated; lying prone with wrists restrained behind back; lying prone with arms free; lying supine with wrists restrained in front. The outcomes measures studied were pulmonary function at 10 min. There was no significant difference in FEV1 or FVC between groups, (one way ANOVA p=0.94 and 0.99, respectively). The difference in FEV1 between the seated position and seated position with wrists restrained behind the back were also compared (p=0.8) as was the effect of wrist restraint in the prone position compared to no restraint prone (p=0.69). However, three subjects could not tolerate the prone position due to a clinical deterioration in symptoms. The response to the prone position with or without wrist restraint appears highly individual, with some individuals tolerating the prone position with no measurable clinical effects and others suffering a clinical deterioration in symptoms. The reasons for this individual variation remain unclear.